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2
Responsible Pain Management
•Amino Acid Based Formula
•No Severe Side Effects
•Reduce Pain, Inflammation & Numbness
•Alternative and Complimentary Therapy
to Commonly Prescribed Medications
3
Indication & Dosing
Percura™
for the dietary management of pain, inflammation and
loss of sensation due to peripheral neuropathy.
DOSAGE AND ADMINISTRATION
Recommended Dosing: 1 or 2 capsules taken 1
to 2 times daily or as directed by physician.
4
Targeted Amino Technology
The efficacy of Percura is driven by a unique ingredient technology that
stimulates the production of specific progenitor cells and neurotransmitters
with specific roles in pain management and cell to cell signaling.
1. Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Wall K. Serum amino acids in fibrositis/fibromyalgia syndrome. J Rheumatol Suppl 1989;19:158-163
2. Shell, et al., “A Double-Blind Controlled Trial of a Single Dose Ibuprofen and an Amino Acid Medical Food Theramine for the Treatment of Low Back Pain; Publication pending, 2010.
There are well documented amino acid deficiencies in patients with chronic pain syndromes.
These deficiencies can alter the metabolic processes associated with neurotransmitter synthesis.
For example, in one double blind study, subjects with chronic back pain who improved low levels
of the amino acids required for production of pain modulating neurotransmitters using a medical
food reported a significant improvement in pain.
5
Amino Acid Levels and Chronic Pain
0
5
10
15
20
25
30
35
Arginine Serine Histidine Tryptophan
Ug/ml Change in Blood Concentration of Amino Acids2
Day 1
Day 28
Normal
N=25
6
Clinical Response Data
In a clinical outcomes study of Percura, patients with peripheral neuropathy
experienced a reduction in pain and numbness over a 56 day period as measured by
a 10 point Physician Global Assessment Visual Analog Scale.
0
1
2
3
4
5
6
7
8
9
Baseline 28 56
VAS
DAYS
Physician Global Assessment Visual Analog Scale
Pain
Numbness
7
Clinical Response Data
-29.5
-23.1
-35
-30
-25
-20
-15
-10
-5
0
Pain Numbness
Physician Global Assessment Visual Analog Scale
Pain Numbness
In a clinical outcomes study of Percura, patients with peripheral neuropathy
experienced a reduction in pain and numbness over a 21 day period as measured
by a 100 point Physician Global Assessment Visual Analog Scale.
8
Nerve Impulse
and Activation
Inflammation
Pain &
Numbness
GABA, Serotonin, Dopamine,
Acetylcholine, Nitric Oxide
and D-serine
Histamine, Nitric
Oxide, Acetylcholine
Inositol Creatine
Improve Clinical Outcomes
• Patients who are
contraindicated for NSAIDs
(High BP, Over 65, CVD,
Taking Aspirin)
• Patients who experience
severe side effects from
Pregabalin or Gabapentin
• Percura can be used as an
adjunct therapy to a low
dose of a drug
9
Alternative to NSAIDs & Anti-Epileptics
10
• Percura can be used as an
adjunct therapy to a low dose
opioid pain medication
• Percura can be used as a
replacement therapy for other
ineffective or dangerous pain
medications
Alternative to Narcotic Pain Medications
Percura is a source of amino acids, biogenic
amines, and botanicals that promote the
production of neurotransmitters responsible for
reducing signals along the ascending and
descending pain pathways and inflammatory
pathways.
Pain and inflammatory conditions increase the
turnover rate of arginine, choline, GABA,
glutamine, histidine, 5-hydroxytryptophan, and
serine. Simple dietary modifications are not
sufficient to satisfy cellular demand and restore
homeostasis to the ascending and descending
pain pathways and inflammatory processes.
11
Neurotransmitter Pathways
Progenitor cells are developmentally
committed to a cell line but are
undifferentiated or immature in
comparison to those cells that have
differentiated and matured
into specialized cells. Progenitor cells
are multipotent or unipotent.
Activation of neuronal progenitor cells
through growth factors such as
creatine can lead to increased cell
division important for the repair process
in peripheral sensory nerves.*
Progenitor Cell Pathways
12
*Murakami, et al. Transplanted neuronal progenitor cells in a peripheral nerve gap promote nerve repair. Brain Research, 2003.
PRECAUTIONS AND CONTRAINDICATIONS
Percura is contraindicated in an extremely small number of patients with
hypersensitivity to any of the nutritional components of Percura.
ADVERSE REACTIONS
Oral supplementation with L-arginine at high doses up to 15 grams daily is
generally well tolerated. The most common adverse reactions of higher doses
- from 15 to 30 grams daily - are nausea, abdominal cramps, and diarrhea.
Percura contains less than 1 gram per dose of amino acids however, some
patients may experience these sympotoms at lower doses. The total combined
amount of amino acids in each Percura capsule does not exceed 500mg.
Safety Information
13
DRUG INTERACTIONS
Percura does not directly influence the pharmacokinetics of
prescription drugs.
OVERDOSE
There is a negligible risk of overdose with Percura as the total
amount of amino acids in a one month supply (120 capsules) is
less than 60 grams. Overdose symptoms may include diarrhea,
weakness, and nausea.
Safety Information Cont.
14
15
1. Fields HL, Heinricher MM, Mason P. Neurotransmitters in nociceptive modulatory circuits. Annu Rev Neurosci 1991;14:219-245.
2. Schaible HG, Ebersberger A, Von Banchet GS. Mechanisms of pain in arthritis. Ann N Y Acad Sci 2002;966:343-354.
3. Zimmermann M. Pathobiology of neuropathic pain. Eur J Pharmacol 2001;429:23-37.
4. Millan MJ. The induction of pain: an integrative review. Prog Neurobiol 1999;57:1-164.
5. Elenkov IJ, Chrousos GP. Stress hormones, proinflammatory and antiinflammatory cytokines, and autoimmunity. Ann N Y Acad Sci 2002;966:290-303.
6. Cuninkova L, Brown SA. Peripheral circadian oscillators: interesting mechanisms and powerful tools. Ann N Y Acad Sci 2008;1129:358-370.
7. Gaillard JM. Neurochemical regulation of the states of alertness. Ann Clin Res 1985;17:175-184.
8. McGinty D, Szymusiak R. The sleep-wake switch: A neuronal alarm clock. Nat Med 2000;6:510-511.
9. Fuller PM, Gooley JJ, Saper CB. Neurobiology of the sleep-wake cycle: sleep architecture, circadian regulation, and regulatory feedback. J Biol Rhythms 2006;21:482-493.
10. Turek FW, Dugovic C, Zee PC. Current understanding of the circadian clock and the clinical implications for neurological disorders. Arch Neurol 2001;58:1781-1787.
11. Belousov AB, O'Hara BF, Denisova JV. Acetylcholine becomes the major excitatory neurotransmitter in the hypothalamus in vitro in the absence of glutamate excitation. J
Neurosci 2001;21:2015-2027.
12. Farber L, Haus U, Spath M, Drechsler S. Physiology and pathophysiology of the 5-HT3 receptor. Scand J Rheumatol Suppl 2004;2-8.
13. Dickenson AH, Chapman V, Green GM. The pharmacology of excitatory and inhibitory amino acid-mediated events in the transmission and modulation of pain in the spinal cord.
Gen Pharmacol 1997;28:633-638.
14. Ernberg M, Lundeberg T, Kopp S. Pain and allodynia/hyperalgesia induced by intramuscular injection of serotonin in patients with fibromyalgia and healthy individuals. Pain
2000;85:31-39.
15. Furst DE, Manning DC. Future directions in pain management. Clin Exp Rheumatol 2001;19:S71-S76.
16. Linderoth B, Stiller CO, Gunasekera L et al. Release of neurotransmitters in the CNS by spinal cord stimulation: survey of present state of knowledge and recent experimental
studies. Stereotact Funct Neurosurg 1993;61:157-170.
17. Hogg RC, Raggenbass M, Bertrand D. Nicotinic acetylcholine receptors: from structure to brain function. Rev Physiol Biochem Pharmacol 2003;147:1-46.
18. Abbadie C, Brown JL, Mantyh PW, Basbaum AI. Spinal cord substance P receptor immunoreactivity increases in both inflammatory and nerve injury models of persistent pain.
Neuroscience 1996;70:201-209.
19. Thomas RJ. Excitatory amino acids in health and disease. J Am Geriatr Soc 1995;43:1279-1289.
20. Dickenson AH. Plasticity: implications for opioid and other pharmacological interventions in specific pain states. Behav Brain Sci 1997;20:392-403.
21. Dickenson AH. NMDA receptor antagonists: interactions with opioids. Acta Anaesthesiol Scand 1997;41:112-115.
22. Oliverio A, Castellano C, Puglisi-Allegra S. Psychobiology of opioids. Int Rev Neurobiol 1984;25:277-337.
23. Ono T, Inoue M, Rashid MH, Sumikawa K, Ueda H. Stimulation of peripheral nociceptor endings by low dose morphine and its signaling mechanism. Neurochem Int 2002;41:399-
407.
24. Ribeiro JA, Sebastiao AM, de MA. Adenosine receptors in the nervous system: pathophysiological implications. Prog Neurobiol 2002;68:377-392.
25. Gallowitsch-Puerta M, Pavlov VA. Neuro-immune interactions via the cholinergic anti-inflammatory pathway. Life Sci 2007;80:2325-2329.
26. Hancock CM, Riegger-Krugh C. Modulation of pain in osteoarthritis: the role of nitric oxide. Clin J Pain 2008;24:353-365.
27. Holthusen H, Arndt JO. Nitric oxide evokes pain at nociceptors of the paravascular tissue and veins in humans. J Physiol 1995;487 ( Pt 1):253-258.
28. Wahl SM, McCartney-Francis N, Chan J, Dionne R, Ta L, Orenstein JM. Nitric oxide in experimental joint inflammation. Benefit or detriment? Cells Tissues Organs 2003;174:26-
33.
29. Efron DT, Barbul A. Modulation of inflammation and immunity by arginine supplements. Curr Opin Clin Nutr Metab Care 1998;1:531-538.
30. Mori M. Regulation of nitric oxide synthesis and apoptosis by arginase and arginine recycling. J Nutr 2007;137:1616S-1620S.
31. Budzinski M, Misterek K, Gumulka W, Dorociak A. Inhibition of inducible nitric oxide synthase in persistent pain. Life Sci 2000;66:301-305.
32. Pelligrino DA, Baughman VL, Koenig HM. Nitric oxide and the brain. Int Anesthesiol Clin 1996;34:113-132.
33. Cerra FB. Nutrient modulation of inflammatory and immune function. Am J Surg 1991;161:230-234.
Select References
For More Information
visit www.tmedpharma.com
16

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Percura, Improve Pain and Numbness Associated with Peripheral Neuropathy

  • 1.
  • 2. 2 Responsible Pain Management •Amino Acid Based Formula •No Severe Side Effects •Reduce Pain, Inflammation & Numbness •Alternative and Complimentary Therapy to Commonly Prescribed Medications
  • 3. 3 Indication & Dosing Percura™ for the dietary management of pain, inflammation and loss of sensation due to peripheral neuropathy. DOSAGE AND ADMINISTRATION Recommended Dosing: 1 or 2 capsules taken 1 to 2 times daily or as directed by physician.
  • 4. 4 Targeted Amino Technology The efficacy of Percura is driven by a unique ingredient technology that stimulates the production of specific progenitor cells and neurotransmitters with specific roles in pain management and cell to cell signaling.
  • 5. 1. Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Wall K. Serum amino acids in fibrositis/fibromyalgia syndrome. J Rheumatol Suppl 1989;19:158-163 2. Shell, et al., “A Double-Blind Controlled Trial of a Single Dose Ibuprofen and an Amino Acid Medical Food Theramine for the Treatment of Low Back Pain; Publication pending, 2010. There are well documented amino acid deficiencies in patients with chronic pain syndromes. These deficiencies can alter the metabolic processes associated with neurotransmitter synthesis. For example, in one double blind study, subjects with chronic back pain who improved low levels of the amino acids required for production of pain modulating neurotransmitters using a medical food reported a significant improvement in pain. 5 Amino Acid Levels and Chronic Pain 0 5 10 15 20 25 30 35 Arginine Serine Histidine Tryptophan Ug/ml Change in Blood Concentration of Amino Acids2 Day 1 Day 28 Normal N=25
  • 6. 6 Clinical Response Data In a clinical outcomes study of Percura, patients with peripheral neuropathy experienced a reduction in pain and numbness over a 56 day period as measured by a 10 point Physician Global Assessment Visual Analog Scale. 0 1 2 3 4 5 6 7 8 9 Baseline 28 56 VAS DAYS Physician Global Assessment Visual Analog Scale Pain Numbness
  • 7. 7 Clinical Response Data -29.5 -23.1 -35 -30 -25 -20 -15 -10 -5 0 Pain Numbness Physician Global Assessment Visual Analog Scale Pain Numbness In a clinical outcomes study of Percura, patients with peripheral neuropathy experienced a reduction in pain and numbness over a 21 day period as measured by a 100 point Physician Global Assessment Visual Analog Scale.
  • 8. 8 Nerve Impulse and Activation Inflammation Pain & Numbness GABA, Serotonin, Dopamine, Acetylcholine, Nitric Oxide and D-serine Histamine, Nitric Oxide, Acetylcholine Inositol Creatine Improve Clinical Outcomes
  • 9. • Patients who are contraindicated for NSAIDs (High BP, Over 65, CVD, Taking Aspirin) • Patients who experience severe side effects from Pregabalin or Gabapentin • Percura can be used as an adjunct therapy to a low dose of a drug 9 Alternative to NSAIDs & Anti-Epileptics
  • 10. 10 • Percura can be used as an adjunct therapy to a low dose opioid pain medication • Percura can be used as a replacement therapy for other ineffective or dangerous pain medications Alternative to Narcotic Pain Medications
  • 11. Percura is a source of amino acids, biogenic amines, and botanicals that promote the production of neurotransmitters responsible for reducing signals along the ascending and descending pain pathways and inflammatory pathways. Pain and inflammatory conditions increase the turnover rate of arginine, choline, GABA, glutamine, histidine, 5-hydroxytryptophan, and serine. Simple dietary modifications are not sufficient to satisfy cellular demand and restore homeostasis to the ascending and descending pain pathways and inflammatory processes. 11 Neurotransmitter Pathways
  • 12. Progenitor cells are developmentally committed to a cell line but are undifferentiated or immature in comparison to those cells that have differentiated and matured into specialized cells. Progenitor cells are multipotent or unipotent. Activation of neuronal progenitor cells through growth factors such as creatine can lead to increased cell division important for the repair process in peripheral sensory nerves.* Progenitor Cell Pathways 12 *Murakami, et al. Transplanted neuronal progenitor cells in a peripheral nerve gap promote nerve repair. Brain Research, 2003.
  • 13. PRECAUTIONS AND CONTRAINDICATIONS Percura is contraindicated in an extremely small number of patients with hypersensitivity to any of the nutritional components of Percura. ADVERSE REACTIONS Oral supplementation with L-arginine at high doses up to 15 grams daily is generally well tolerated. The most common adverse reactions of higher doses - from 15 to 30 grams daily - are nausea, abdominal cramps, and diarrhea. Percura contains less than 1 gram per dose of amino acids however, some patients may experience these sympotoms at lower doses. The total combined amount of amino acids in each Percura capsule does not exceed 500mg. Safety Information 13
  • 14. DRUG INTERACTIONS Percura does not directly influence the pharmacokinetics of prescription drugs. OVERDOSE There is a negligible risk of overdose with Percura as the total amount of amino acids in a one month supply (120 capsules) is less than 60 grams. Overdose symptoms may include diarrhea, weakness, and nausea. Safety Information Cont. 14
  • 15. 15 1. Fields HL, Heinricher MM, Mason P. Neurotransmitters in nociceptive modulatory circuits. Annu Rev Neurosci 1991;14:219-245. 2. Schaible HG, Ebersberger A, Von Banchet GS. Mechanisms of pain in arthritis. Ann N Y Acad Sci 2002;966:343-354. 3. Zimmermann M. Pathobiology of neuropathic pain. Eur J Pharmacol 2001;429:23-37. 4. Millan MJ. The induction of pain: an integrative review. Prog Neurobiol 1999;57:1-164. 5. Elenkov IJ, Chrousos GP. Stress hormones, proinflammatory and antiinflammatory cytokines, and autoimmunity. Ann N Y Acad Sci 2002;966:290-303. 6. Cuninkova L, Brown SA. Peripheral circadian oscillators: interesting mechanisms and powerful tools. Ann N Y Acad Sci 2008;1129:358-370. 7. Gaillard JM. Neurochemical regulation of the states of alertness. Ann Clin Res 1985;17:175-184. 8. McGinty D, Szymusiak R. The sleep-wake switch: A neuronal alarm clock. Nat Med 2000;6:510-511. 9. Fuller PM, Gooley JJ, Saper CB. Neurobiology of the sleep-wake cycle: sleep architecture, circadian regulation, and regulatory feedback. J Biol Rhythms 2006;21:482-493. 10. Turek FW, Dugovic C, Zee PC. Current understanding of the circadian clock and the clinical implications for neurological disorders. Arch Neurol 2001;58:1781-1787. 11. Belousov AB, O'Hara BF, Denisova JV. Acetylcholine becomes the major excitatory neurotransmitter in the hypothalamus in vitro in the absence of glutamate excitation. J Neurosci 2001;21:2015-2027. 12. Farber L, Haus U, Spath M, Drechsler S. Physiology and pathophysiology of the 5-HT3 receptor. Scand J Rheumatol Suppl 2004;2-8. 13. Dickenson AH, Chapman V, Green GM. The pharmacology of excitatory and inhibitory amino acid-mediated events in the transmission and modulation of pain in the spinal cord. Gen Pharmacol 1997;28:633-638. 14. Ernberg M, Lundeberg T, Kopp S. Pain and allodynia/hyperalgesia induced by intramuscular injection of serotonin in patients with fibromyalgia and healthy individuals. Pain 2000;85:31-39. 15. Furst DE, Manning DC. Future directions in pain management. Clin Exp Rheumatol 2001;19:S71-S76. 16. Linderoth B, Stiller CO, Gunasekera L et al. Release of neurotransmitters in the CNS by spinal cord stimulation: survey of present state of knowledge and recent experimental studies. Stereotact Funct Neurosurg 1993;61:157-170. 17. Hogg RC, Raggenbass M, Bertrand D. Nicotinic acetylcholine receptors: from structure to brain function. Rev Physiol Biochem Pharmacol 2003;147:1-46. 18. Abbadie C, Brown JL, Mantyh PW, Basbaum AI. Spinal cord substance P receptor immunoreactivity increases in both inflammatory and nerve injury models of persistent pain. Neuroscience 1996;70:201-209. 19. Thomas RJ. Excitatory amino acids in health and disease. J Am Geriatr Soc 1995;43:1279-1289. 20. Dickenson AH. Plasticity: implications for opioid and other pharmacological interventions in specific pain states. Behav Brain Sci 1997;20:392-403. 21. Dickenson AH. NMDA receptor antagonists: interactions with opioids. Acta Anaesthesiol Scand 1997;41:112-115. 22. Oliverio A, Castellano C, Puglisi-Allegra S. Psychobiology of opioids. Int Rev Neurobiol 1984;25:277-337. 23. Ono T, Inoue M, Rashid MH, Sumikawa K, Ueda H. Stimulation of peripheral nociceptor endings by low dose morphine and its signaling mechanism. Neurochem Int 2002;41:399- 407. 24. Ribeiro JA, Sebastiao AM, de MA. Adenosine receptors in the nervous system: pathophysiological implications. Prog Neurobiol 2002;68:377-392. 25. Gallowitsch-Puerta M, Pavlov VA. Neuro-immune interactions via the cholinergic anti-inflammatory pathway. Life Sci 2007;80:2325-2329. 26. Hancock CM, Riegger-Krugh C. Modulation of pain in osteoarthritis: the role of nitric oxide. Clin J Pain 2008;24:353-365. 27. Holthusen H, Arndt JO. Nitric oxide evokes pain at nociceptors of the paravascular tissue and veins in humans. J Physiol 1995;487 ( Pt 1):253-258. 28. Wahl SM, McCartney-Francis N, Chan J, Dionne R, Ta L, Orenstein JM. Nitric oxide in experimental joint inflammation. Benefit or detriment? Cells Tissues Organs 2003;174:26- 33. 29. Efron DT, Barbul A. Modulation of inflammation and immunity by arginine supplements. Curr Opin Clin Nutr Metab Care 1998;1:531-538. 30. Mori M. Regulation of nitric oxide synthesis and apoptosis by arginase and arginine recycling. J Nutr 2007;137:1616S-1620S. 31. Budzinski M, Misterek K, Gumulka W, Dorociak A. Inhibition of inducible nitric oxide synthase in persistent pain. Life Sci 2000;66:301-305. 32. Pelligrino DA, Baughman VL, Koenig HM. Nitric oxide and the brain. Int Anesthesiol Clin 1996;34:113-132. 33. Cerra FB. Nutrient modulation of inflammatory and immune function. Am J Surg 1991;161:230-234. Select References
  • 16. For More Information visit www.tmedpharma.com 16

Editor's Notes

  1. Example Continued: Decrease in Choline means decreased parasympathetic autonomic nervous system activity due to pain disorder. Decrease in choline causes increased creatine phosphokinase and alanine transaminase, and must be addressed. With Theramine: Administration of choline increases production of acetylcholine which reduces transmission of pain signals and inhibits proinflammatory cytokines and substance P release without noxious side effects related to harmful drugs